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Tomorrow I am going to make an appointment with the doctor for a general check-up/physical, and also scheduling to see an OBGYN, to get a new prescription of birth control pills, and to make sure I am in good health. It’s another year before I have to get a pap smear, being 22, and I am not sure if I qualify as “sexually active” under the hilariously limited definitions I have heard before, and I had the HPV vaccine before I turned 18. But I still keep up on my gynaecological health, since ovarian cancer is very common among Ashkenazi Jews.

But autism and gynaecology don’t usually mesh well. After all, it involves a lot of uncomfortable touching, bright lights, unusual instruments that vary in temperature, and other factors that may make adult autistics with uteri skip out on seeing the OBGYN. This concerns me, because I do not want autistic adults slipping through the cracks and facing serious health issues because of this discomfort issue.

I do not know if any books, lectures, or seminars have been given to OBGYNs on how to be courteous and accommodating to autistic patients, but I think autistic gynaecological health would be vastly improved if they understood how to address autistic patients, treat them properly, and understand their health and comfort needs during the appointment. For both patients and OBGYNs, here’s some things that could be done to improve the autistic experience at the OBGYNs (or any doctor’s appointment really)

+ When using instruments that will come in direct contact with sensitive areas, make sure you do a temperature test on both the instrument and the lubricant. Ten minutes in a bowl of warm water could mean a significant increase in comfort for both parties. Not all may like it warm, so ask for the preference first, maybe a touch test to see. Do not be afraid to ask for excess lubricant, and if you have any allergies/sensitivities to lubricants you are aware of, try bringing in your own special sensory-friendly lube.

+ Ask questions in as neutral a manner as possible, and modify vocabulary appropriate to the patient’s understanding. “Are you sexually active” is bloody vague, and may not be understood by a patient with an intellectual disability, so be patient and use a definition they understand. Explain what you mean without being condescending or treating the patient like a child.

+ Don’t judge. If your patient is having a hard time, don’t tell them to “suck it up”, ask what you can do to make it better.

+ If your office has fluorescent lighting, make sure they aren’t buzzing, that’s uncomfortable and distracting. If your office has a window, it can be irritating to have the changing patterns of light or colour play across the glass/between the slats of blinds/across curtains. Keep some white-out materials on hand to block distracting windows, and keep a compressing face mask on hand if the patient wants one. The patient doesn’t need to see during the procedure.

+ If you’re not asking questions, let the patient listen to music, hug a stim toy, or read a book. If you need to ask a question, try agreeing on a code to let the patient know you want their attention, like a code word or a tap on the knee. That way they know to pay attention.

+ Keep some weighted blankets around, they are very relaxing and can be draped over the patient without interfering with the procedures in most cases.

+ Another idea to help a particularly antsy/sensitive patient is to have a bowl of chocolates/candy/dried fruit on hand, and if they want one, give one to them to suck on during the check up, so they have something to think about besides the doctor poking around their genitalia.

+ Don’t assume that because we’re autistic/disabled, that we don’t have a sex life, a sexual identity, or don’t need to know what neurotypicals are told. Talk to us about safe sex, contraceptives, masturbation, consent, and health. Ignorance is not bliss.

Anything else? Please let me know in the comments. I think this is a criminally under-discussed topic.

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